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Results for “Institutionalization”

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PubMed2000

[Model of costs of care for dementia: community-dwelling vs. institutionalization].

This article describes a model of costs for Alzheimer's Disease. The cost of institutionalization and the cost of living at home for patients with Alzheimer's Disease are calculated and compared. The average yearly cost of living at home is 10,810 Dutch guilders for male patients and 12,771 Dutch guilders for female patients (prices of 1996). Institutionalization is considerably more expensive: the average yearly cost associated with admission to a residential home is 48,180 Dutch guilders and 98,915 versus 102,930 Dutch guilders for costs associated with admission to a specialised respectively nonspecialized nursing home. Differences between men and women could not be taken into account in these last three estimations. The cost of living at home increases when the cost of informal care is included. However, when the cost were valued with a tariff of 29.50 guilders per hour, institutionalisation remains more expensive than living at home. This is also the case for severely demented patients, as the costs of institutions are also related to the level of care.

Alzheimer Disease↗

PubMedDate not supplied

Oral health and treatment needs in institutionalized psychiatric patients in India.

The caries prevalence, oral hygiene status, periodontal health and treatment needs were evaluated in a group of institutionalized psychiatric patients in Goa, India. Of the total 153 inmates, males constituted 59 percent, the mean age was 25 years, 96 percent were self sufficient and the response rate was 84 percent. 63 percent were diagnosed with schizophrenia. They did not receive any assistance in daily self-care activities including oral hygiene maintenance. None of the 5 edentulous patients had dentures, 5% had been referred for emergency dental care during the period of institutionalization. 15 subjects (12%) were caries-free, the stepwise linear regression analysis showed that the mean DMFT index significantly increased with age (t = 2-819, PL 0.05). Two third of the study population (88%) were in need of conservative dental treatment. The stepwise linear regression analysis showed that the mean OHI-S index significantly increased with age (t = 2.412, P < 0.01). Only 5.4% reported a healthy periodontium whereas 16.27% required complex periodontal therapy. Soft tissue lesions included dorsal lingual depapillation/heavily coated areas and angular cheilitis in addition to incidental observations such as mucosal hyperpigmentation, gingival hyperplasia, and leucoedema. Bruxism and factitious injuries were also noted. The onus of meeting the oral health needs of this marginalized patient population therefore depends on the effectiveness of community dentistry programs vis a vis the efforts of the staff of the institution to provide such services on a regular basis.

Adult↗

PubMed2002

[Prevalence and etiology of anemia in an institutionalized geriatric population].

OBJECTIVE: Anemia is a common problem in the elderly, but its etiology in this age group is not well known, nor is its correlation with the mental and functional states. The objectives of the present study were to determine the prevalence of anemia in a large institutionalized geriatric population, to diagnose the etiology, and to analyze the correlation of anemia with the nutritional, mental and functional status. METHODS: The study was performed in a 970 bed multilevel geriatric complex, from which 481 residents were randomly chosen. Their mean age was 81.4 +/- 8.7 years, and 46 of these residents were independent, 162 frail, and 273 nursing home patients. RESULTS: High prevalence of anemia (31.4%) was found, but, in more than half of the cases, the anemia was mild. The most common diagnosis was anemia of chronic disorders (65.6%), followed by anemia of chronic renal failure (13.2%). Anemia primarily due to iron, vitamin B12 or folate deficiency was found to be only 4%. In 15.9% of these cases the main cause of anemia could not be resolved. No correlation with the nutritional or cognitive states was found, but the functional state was highly and significantly inversely correlated with the presence of anemia. CONCLUSIONS: Anemia in institutionalized elderly is mostly the consequence of other chronic diseases. Further studies are required to determine whether a low functional state is an independent risk factor for anemia in old age.

Aged↗

PubMed1976

Responses to frustration: comparison of institutionalized and noninstitutionalized retarded adolescents and nonretarded children and adolescents.

Thirty adolescents (10 institutionalized retarded, 10 noninstitutionalized retarded, 10 nonretarded CA-matched) and 10 children (nonretarded MA-matched) were individually given the Rosenzweig Picture-Frustration Study (Children's Form). Responses were scored for direction of blame and reaction type, yielding nine frustration response categories. Three of the nine response categories showed significant group relationships. Retardation, institutionalization, and CA were all found to have an effect on responding, although analysis of response profiles showed all groups to be very similar in response pattern.

Adolescent↗

PubMed2002

Dietary intake analysis in institutionalized elderly: a focus on nutrient density.

BACKGROUND: Inadequate food intake in old age can lead to marginal or suboptimal nutrient intakes causing the deterioration of physiological and health states. OBJECTIVE: To describe, by intake assessment, nutritional status of institutionalized elderly and to compare the data to other studies findings. DESIGN: Dietary intake was assessed in 50 (18 males, 32 females, average age 84 6 years) institutionalized elderly according to data collected by using structured food frequency questionnaires based on the institutional kitchen recipes, weekly menu and portion size. RESULTS: Daily energy intake was 1.91 0.48 Mcal and energy density was 4.97 kcal/g dry matter. Energy derived from protein and fat was 15.1% and 35.4%, respectively. Dietary fiber consumption was very low, 3.92 g/Mcal. Calcium intake of all of the subjects, and magnesium, zinc and copper intakes of most of them, were low. Iron intake of almost all of the subjects was sufficient or above RDA. Intake of vitamins D, E, B6, thiamin (vitamin B1) and folic acid in all or most of the subjects was low. In almost all of the 39 studies and reviews, including ours, densities of at least two nutrients did not meet the calculated RDA density. Particularly low were the nutrient densities of vitamins C and E, thiamin, vitamin B6, folic acid and vitamin D, as well as of calcium, magnesium, zinc and copper. CONCLUSION: Supplementation with half the RDA of micronutrients (except for vitamin A and iron) may result in micronutrient intakes that are higher than two-thirds of the RDA.

Aged↗

PubMed2003

Dementia and Nutrition. Intervention study in institutionalized patients with Alzheimer disease.

OBJECTIVES: To know nutritional status of a group of institutionalized patients with moderate Alzheimer's Disease (AD), and to ascertain the effects of an intervention with nutritional supplements on morbidity and mortality after one year follow-up. PATIENTS AND METHODS: 99 patients (mean age: 86.5 years), 80 women, with a diagnosis of AD according with NINCDS/ADRDA criteria, were recruited from 8 nursing-homes. 25 were included in an intervention group and received a nutritional supplements along 12 months. Evolution was evaluated according to the Functional Assessment Staging Test (FAST). Patients with FAST levels 5-6 were included. General clinical variables as well as variables reflecting cognitive state and nutritional status: anthropometric, biochemical data and Mini Nutritional Assessment (MNA) were analysed. Statistical analysis was carry out with the SPSS 10.0 package. RESULTS: Mean time since diagnosis was 49 months, with a 20.2 months duration of institutionalization. Mean value of MNA was 20.1 3.5. 16.5% of patients had a BMI equal o lower than 21. After one year the intervention group showed higher levels of albumin (P=05), pre-albumin (P=05), iron (P=01), zinc (P=05), and beta-carotene (P=05) than the control group. The same response in BMI (P=05), MNA (P=05), and triceps skinfold (P=01). Mortality was lower (16% vs. 22.7%), without statistical significance, in the intervention group, as it was the number of infectious events (47% vs. 66% P=05), and the days in bed (7.5 2.1 vs. 17.3 5.6 P=05). CONCLUSION: Nutritional supplements applied to a group of patients with AD living in nursing-homes can reduce morbidity and mortality after one year follow-up.

Aged↗

PubMed2003

[Falls in institutionalized elderly subjects. Features and geriatric assessment].

BACKGROUND: Falls are an important cause of disability and mortality among elderly subjects. AIM: To study the features and incidence of falls in institutionalized elderly subjects. PATIENTS AND METHODS: Prospective recording of all falls, occurring in a period of eight months, to 453 subjects older than 60 years, living a home for the elderly. Evaluation of functional status of subjects suffering falls, using the Spanish Red Cross score. One hundred and two subjects living in the same place, but not suffering falls, were considered as controls. RESULTS: One hundred and three subjects, aged 80 +/- 6 years (24% of the sample) suffered falls. Most falls were during the day and while walking. Seventy percent of subjects suffering falls did not have a history of previous falls. Nine percent of those falling, suffered a fracture. Compared to controls, falling subjects had a more deteriorated functional and mental status and consumed more benzodiazepines and neuroleptics. CONCLUSIONS: There is an association between functional status and psychotropic medication consumption and the incidence of falls in institutionalized elderly subjects.

Accidental Falls↗

PubMedDate not supplied

[Therapeutic interchange between angiotensin II receptor blockers in institutionalized elderly patients. Implimenting a protocol].

OBJECTIVE: To assess the effectiveness of a therapeutic interchange protocol for angiotensin II receptor blockers (ARB's) in the maintenance of blood pressure levels for institutionalized elderly patients diagnosed with hypertension. METHODS: A new protocol was discussed by the Pharmacy and Therapeutics Committee, and its implementation by the Pharmacy Department was authorized. The protocol specifies equivalent doses between drugs and the patients' clinical follow-up. Criteria used in the assessment includes: need to change dosage for an ARB included in the Pharmacotherapeutic Guide, and blood pressure changes after drug interchange. RESULTS: In the absence of hepatic insufficiency, the protocol may replace the standard doses of any drugs within this group with losartan 50 mg daily. If needed, the dose of losartan may be increased to 100 mg daily divided into two doses. Eighteen patients, which represent 10% of all interchange operations carried out by the Pharmacy Department, were included in this study. Blood pressures both before and after the interchange process show no major differences between them. Only two patients required an increase in the dose of losartan. CONCLUSION: The implementation of a therapeutic interchange protocol as agreed upon by the Pharmacy and Therapeutics Committee allows the clinical follow-up of patients and therefore facilitates an evaluation of the process. This ARB interchange protocol, as suggested for the institutionalized elderly population setting, has proven effective in maintaining anti-hypertensive activity.

Aged↗

PubMed1992

Malnutrition in the institutionalized older adult.

Most older adults in the United States live at home and are well nourished. Approximately 5% to 6% reside in nursing homes, and this segment of the older population typically suffers from multiple diseases that contribute to a high incidence of malnutrition. Forty percent of hospital beds are occupied by older persons. This article addresses the causes of malnutrition in older persons institutionalized in long-term and acute-care facilities. The causes include changes in nutrient requirements secondary to disease processes and drug modalities in combination with low or marginal dietary intake. Infections are common and result in anorexia, poor dietary intake, and malnutrition, which predispose the patient to another infection. Occurrence of decubitus ulcers is related to nutritional status and presents a serious risk for older persons with limited mobility. Depression and dementia are commonly seen in older persons and are major contributors to poor appetite and malnutrition. Cancer cachexia accounts for about half of the cases of malnutrition in older institutionalized persons. Physiologic changes that occur with age and multiple drug use place older persons at a high risk for adverse drug reactions. Less body water in the older individual influences and complicates many aspects of treatment. Standards, methods, and interpretation of nutritional assessment measurements in older persons differ from those in younger adults. The nutrition care provider must carefully consider many complex physical, medical, and psychosocial factors to deliver individualized nutrition care.

Aged↗

PubMed2004

A 6-month follow-up of nutritional status in institutionalized patients with Alzheimer's disease.

OBJECTIVE: A follow up of nutritional status in institutionalized patients with Alzheimer's disease. DESIGN: Observational study. SETTING: Specialized unit for patients with Alzheimer's disease in Dijon hospital, France. SUBJECTS: Fourteen women, aged 72-92 years. ASSESSMENTS: On admission of patients to the specialized unit for dementia, body weight, body mass index, arm muscle circumference (AMC) and triceps skin fold (TSF) were measured. Serum concentrations of albumin, prealbumin, homocysteine, orosomucoide, calcium, folates, vitamins B12 and B6 and C-reactive protein were recorded. The same clinical and biological measurements were repeated at day 30, 90 and 180. RESULTS: Both mean weight and mean BMI increased throughout the study with significant differences between day 0 and day 90, and day 180 (p<0.01). The weight gain was associated with a significant increase in AMC and TSF (p<0.01 and p<0.001, respectively). There was no significant difference for values of both mean serum levels of albumin and prealbumin between day 0 and day 180. Whatever the period, serum concentrations of folates and vitamin B12 were in the normal range, while mean levels of vitamin B6 were lower than the normal range; For all these values, there was no significant difference between day 0, 30, 90, 180. Mean levels of C-reactive protein and orosomucoide and lymphocyte counts were in the normal range both at admission and day 180. No significant difference was noted between value of homocysteine at admission and at day 180. CONCLUSION: In this special care unit, the patients with Alzheimer's disease who take part in daily activities and particularly preparation of the meal don't lose weight. It is certain that future studies recording food intake and energy expenditure are necessary to explain the benefits in the nutritional status observed in patients showing dementia when they are institutionalized in a special unit.

Aged↗

PubMedDate not supplied

Influence of mental status on removable prosthesis compliance in institutionalized elderly persons.

PURPOSE: It is well-recognized that many institutionalized elderly persons with dementia do not wear dentures. The objective of this study was to evaluate the current status of denture use among elderly patients with dementia, in association with degree of mental impairment, to provide information relating to a decision-making process for optimal denture treatment. MATERIALS AND METHODS: From August 2001 to December 2002, 101 hospitalized elderly persons in a geriatric hospital dental clinic received removable denture treatment by two certified prosthodontists. Prior to denture treatment, patient mental status was evaluated using the Mini Mental Status Examination (MMSE). Basic activities of daily living, including mobility, feeding, toilet use, dressing, and bathing, were also evaluated. Denture acceptance was determined 6 months after denture delivery. RESULTS: Eight patients were excluded; 73 patients had accepted their dentures and 20 had not 6 months after denture delivery. The mean MMSE score for patients who did not accept denture delivery (11.7+/-7.0) was significantly lower than that of those who did accept and wear their dentures (16.0+/-6.8). CONCLUSION: The cognitive status of institutionalized elderly persons with dementia should be a criterion for clinical decision making relating to denture treatment.

Activities of Daily Living↗

PubMed1992

Psychosocial characteristics of institutionalized adolescents: resilient or at risk?

The primary purpose of this investigation was to provide a psychosocial description of 187 institutionalized adolescents (ages 11-17). The findings suggest that these adolescents may not be as psychologically dysfunctional as is commonly surmised, considering their accumulated life events, family problems, and current displacement. Although the literature is replete with studies that describe characteristics purported to typify at-risk adolescents, there is no substantive demographic base concerning institutionalized adolescents. The authors acknowledge the limitations inherent in their sample and, consequently, offer their findings as a "place to start," and encourage others to follow this line of research.

Adolescent↗

PubMedDate not supplied

Generalized expectancy, situational perception, and morale among institutionalized aged.

This article was based on a larger study which sought to identify selected personality and situational variables that contribute to high morale of the institutionalized elderly. The relationship of generalized expectancy of control and perceived situational control to morale of the institutionalized aged was examined within a framework developed for the study. Locus of control, self-report, trust, self-rated health, and the Revised Philadelphia Geriatric Morale scales as well as a situational control of daily activities (SCDA) interview schedule were administered individually to 30 residents, aged 65 to 96, in four skilled nursing facilities. Congruence between internal orientation and self-determined SCDA resulted in higher morale than incongruence; however, congruence between external orientation and other-determined situations resulted in lower morale than incongruence.

Adaptation, Psychological↗

PubMed1989

Institutionalization of the elderly and characteristics of nursing home patients.

To characterize nursing home patients and to study the prevalence of institutionalization 191 patients living in four somatic nursing homes in western Sweden were investigated. Of the total population over 65 years 7.8% were institutionalized, 2.6% in somatic nursing homes. The need for care increased markedly after 80 years of age. Most commonly (45%), the patients were admitted from emergency somatic wards. The mean age was 82.5 years, 74% were single and 60% were women. The mean period of care was 1.82 years. 87% had more than one diagnosis. The most common diseases concerned the circulatory system (51%) and the musculoskeletal system (43%). Dementia was diagnosed in 41% at admittance, but functional tests revealed a much higher frequency (72%). Conclusions. The nursing home patient was very old, was mostly single and had multiple diseases. The prevalence of dementia was high.

Age Factors↗

PubMed1989

Toward a model for improved targeting of aged at risk of institutionalization.

A national sample of institutionalized and noninstitutionalized aged was created by merging the 1977 National Nursing Home Survey and its counterpart, the National Health Interview Survey for the same year. A weighted logistic regression analysis was conducted to identify factors that might be useful in calculating home- and community-based long-term care clients' risk of institutionalization. A model containing patient characteristics, nursing home bed supply, and a climate variable correctly classified 98.2 percent of cases residing in nursing homes or the community. Physical dependency, mental disorder and degenerative disease, lack of spouse, being white, poverty, old age, unoccupied nursing home beds, and climate all appear to be determinants of institutional residency among the aged.

Activities of Daily Living↗

PubMedDate not supplied

Hypercalciuria in chronically institutionalized bedridden children: frequency, predictive factors and response to treatment with thiazides.

Calcium and creatinine concentrations were analyzed in urine samples of 42 chronically institutionalized bedridden children, with neurologic disorders. Their ages ranged from 2 to 16 (mean 8.7) years. Hypercalciuria, defined as UCa/UCr ratio greater than 0.21, was recognized in 18 children (42.8%), the mean UCa/UCr ratio of this group was 0.40 +/- 0.18. Twenty-four children were normocalciuric, with a mean UCa/UCr ratio of 0.08 +/- 0.03. There were no significant differences between the two groups with regard to age, sex, length of institutionalization, the basic neurologic disorder, diet, anticonvulsive medications, exposure to sunlight and weekly hours of physiotherapy. Age- and sex-matched percentiles for fat and muscle areas were similar in both groups. Seven limb fractures had occurred in the hypercalciuric group during the last three years, but only in one of the normocalciuric patients (p less than 0.02). The hypercalciuric children were treated with a hydrochlorothiazide-amiloride preparation for three weeks, which resulted in reduction of their mean UCa/UCr ratio by 57.7%, to 0.17 +/- 0.13 (p less than 0.005); only four children remained hypercalciuric. We conclude that resorptive hypercalciuria is common among chronically immobilized bedridden children. Hypercalciuria in such children should be specifically looked for, because of its association with deranged bone metabolism and increased frequency of limb fractures. Treatment with thiazides was found to be efficient in reducing urinary calcium excretion in our hypercalciuric patients. This therapeutic modality for the reduction of morbidity in bedridden chronically immobilized children should be further explored.

Adolescent↗

PubMed1987

Nutritional status of non institutionalized elderly people in north Italy.

The nutritional status of some elderly people - 313 non institutionalized and 37 assisted by public organization - was investigated. As regards weight, muscle and fat area, BMI and fat %, lower values were found for assisted people. The mean daily nutrient intakes in assisted people are below the recommended values for all nutrients, except fats; free living people have higher intakes of protein and fat, and lower intakes of thiamin and retinol equivalents. About 10% and 15% of non institutionalized people showed respectively an inadequate thiamin and riboflavin nutritional status (determined by alpha ETK and TPP levels and by alpha EGR and FAD levels); a worse situation was found for assisted people. Vitamin B6 levels appear adequate for all the population tested.

Aged↗

PubMed1986

Effects of types of institutionalization on responsiveness to social reinforcement, wariness, and outerdirectedness among low-MA residents.

The ways in which institutional factors and psychological characteristics of residents interact to determine the behavioral effects of institutionalization were investigated. Two large and five small institutions were rated on resident management practices, aide attitudes, and demographic variables, such as size and cost per resident. Resident variables included preinstitutional deprivation, CA, MA, IQ, and length of institutionalization. The institution and resident variables were used in an attempt to predict three aspects of behavior: responsiveness to social reinforcement, wariness, and outerdirectedness. Of the predictor variables, only MA was related to all three. As in earlier research, institutional variables were not predictive of the behaviors examined.

Adult↗